液体浸润式飞秒激光平台辅助的白内障手术初步研究

Preliminary clinical research on liquid-immersion femtosecond laser assisted cataract surgery

目的观察液体浸润式飞秒激光辅助的白内障手术(femtosecond laser assisted cataract surgery,FLACS)的临床安全性及有效性。方法前瞻性研究。选择2013年10月至2014年4月间我院年龄相关性白内障患者70例(70眼),FLACS组35例,行液体浸润式Lens AR FLACS,超声组35例,行常规白内障超声乳化吸出术。于术后1 d、1周、1个月及3个月对所有患者进行随访,记录裸眼视力(UCVA)、最佳矫正视力(BCVA)、结膜充血及睫状充血、角膜厚度、房水蛋白浓度及角膜内皮细胞计数等,并进行统计学分析。结果 FLACS组35例患者均顺利完成手术。FLACS组术中超声时间及超声能量分别为(23.25±7.21)s、7.91%±2.75%,均低于超声组的(34.08±8.59)s、16.95%±4.60%(均为P=0.000)。术后1 d及1周,FLACS组Log MAR视力UCVA及BCVA、角膜厚度均较超声组低。术后1周、3个月,FLACS组角膜内皮细胞丢失率分别为9.63%±3.67%、11.22%±3.77%,均较超声组的13.29%±4.62%、15.16%±5.02%低,差异均有统计学意义(均为P=0.000)。术后1 d、1周、1个月,FLACS组房水蛋白浓度分别为(16.88±4.76)nc·s-1、(14.12±4.96)nc·s-1、(9.71±3.83)nc·s-1,均较超声组低(均为P<0.05)。术后1 d两组间结膜充血及睫状充血分级差异均无统计学意义(均为P>0.05)。结论液体浸润式FLACS具有临床安全性及有效性,在减少眼部组织损伤,提高术后早期视力恢复方面具有一定的优势。

Objective T o observe the safety and effectiveness of liquid-immersion femtosecond laser assisted cataract surgery( FLAC S). Methods A prospective study w as conducted in together 70 age-related cataract patients( 70 eyes) betw een O ctober2013 and April 2014,and these subjects w ere randomly divided into tw o groups: FLAC S group,35 patients undergoing liquid-immersion LensAR FLAC S,and ultrasound group,35 patients receiving conventional phacoemulsification. All patients w ere follow ed up 1 day,1 w eek,1 month and 3 months after operation. T he variables, including uncorrected distance visual acuity( U C VA),best corrected distance visual acuity( BC VA),redness analysis,corneal thickness,aqueous humor protein concentration and corneal endothelial cell count w ere recorded and analyzed. Results All procedures in the FLAC S group w ere successful. T he ultrasound time and energy in the FLAC S group w ere statistically less than those in the ultrasound group[( 23. 25 ± 7. 21) s,( 7. 91% ± 2. 75%) vs.( 34.08 ± 8. 59) s,( 16. 95% ± 4. 60%) ]( both P = 0. 000). T he LogM AR U C VA and LogM AR BC VA w ere better and the corneal thickness in FLAC S group w ere statistically less than those in the ultrasound group postoperative 1 day and 1 w eek( all P < 0. 05). And the corneal endothelial cell loss rate in the FLAC S group w as statistically low er than that in the ultrasound group postoperative 1 w eek and 3 months[( 9. 63% ± 3. 67%),( 11.22% ± 3. 77%) vs.( 13. 29% ± 4. 62%),( 15. 16% ± 5. 02%) ]( all P = 0. 000). O ne day,1 w eek and 1 month after operation,the aqueous humor protein concentration in the FLACS group[( 16. 88 ± 4. 76) nc·s^(-1),( 14. 12 ± 4. 96) nc·s^(-1),( 9. 71 ± 3. 83) nc·s^(-1)]was lower than those in the ultrasound group( all P < 0. 05). However,there was no significant difference in conjunctival hyperemia and ciliary congestion between the two groups at 1 day after operation( all P > 0. 05). Conclusion T he liquid-immersion FLACS is efficient and safe for assisting cataract surgery that may have some advantages in reducing tissue damage and improving postoperative early visual recovery.